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The ABC-D score improves the sensitivity in predicting need for massive transfusion in pediatric trauma patients
Ryan Phillips1, Shannon N Acker1, Niti Shahi1
1Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Insights
The ABCD score, incorporating base deficit and lactate, improves the identification of pediatric trauma patients needing massive transfusion. This enhanced scoring system aids in early and accurate clinical decision-making for critical care.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Critical Care Medicine
Background:
- Accurate identification of pediatric trauma patients requiring massive transfusion (MT) is challenging.
- Current MT activation criteria lack established guidelines for children.
- The ABC score adjusted for pediatric age (ABC-S) shows limited improvement in sensitivity for MT prediction.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the ABC score, ABC-S, and a novel ABCD score (ABC-S plus base deficit and lactate) for predicting MT in pediatric trauma patients.
- To determine if the ABCD score improves the sensitivity and specificity of MT activation compared to existing scores.
Main Methods:
- Retrospective review of pediatric trauma patients (1-18 years) who received packed red blood cell (pRBC) transfusion from 2008-2018.
- Calculation and comparison of sensitivity, specificity, and accuracy for ABC, ABC-S, and ABCD scores in predicting MT.
- Analysis of patient characteristics including Injury Severity Score, lactate, base deficit, and mortality.
Main Results:
- The ABCD score demonstrated the highest predictive ability for MT, with an Area Under the Curve (AUC) of 0.805.
- An ABCD score of 3 or greater achieved 77.4% sensitivity and 78.8% specificity for MT prediction.
- Pediatric trauma patients requiring MT exhibited significantly higher Injury Severity Scores, lactate levels, and base deficits, along with increased mortality.
Conclusions:
- The ABCD score significantly enhances the sensitivity for activating massive transfusion protocols in pediatric trauma.
- This novel scoring system offers a more accurate tool for early identification and management of pediatric trauma patients at risk for massive transfusion.
Purpose:
Early and accurate identification of pediatric trauma patients who will require massive transfusion (MT) remains difficult, and MT activation criteria are not well established. In children, the addition of shock index-pediatric age-adjusted (SIPA) to the ABC score (ABC-S) only modestly improves the sensitivity of the ABC score. We hypothesized that the discriminate ability of the ABC-S score would improve with the addition of elevated serum lactate and base deficit (ABCD score).
Methods:
We identified children between 1 and 18 years old who received a pRBC transfusion between 2008 and 2018 from our trauma registry. We calculated sensitivity, specificity, and accuracy of the ABC, ABC-S, and ABCD scores to determine the need for MT.
Results:
We included 211 children, of which 66 required MT. The best predictor of MT was achieved by adding BD and lactate to the ABC-S score, with an AUC of 0.805. An ABCD score of 3 or greater was 77.4% sensitive and 78.8% specific at predicting the need for MT. Pediatric trauma patients that required MT had higher injury severity score (p = 0.005), lactate (p = 0.002), base deficit (p = <0.0001). Mortality was higher in the MT group (45.5% vs 15.3%, p = 0.0004).
Conclusions:
The ABCD score improves the sensitivity of activating MT in pediatric trauma patients.
Study Type:
Treatment Study.
Level Of Evidence:
Level III.
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